Provider Demographics
NPI:1417260563
Name:IF HOSPICE OPCO LLC
Entity Type:Organization
Organization Name:IF HOSPICE OPCO LLC
Other - Org Name:SOLACE HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GREGORY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-346-7807
Mailing Address - Street 1:PO BOX 1784
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83403-1784
Mailing Address - Country:US
Mailing Address - Phone:208-757-8444
Mailing Address - Fax:208-965-8351
Practice Address - Street 1:197 STOCKHAM BLVD
Practice Address - Street 2:SUITE 2B
Practice Address - City:RIGBY
Practice Address - State:ID
Practice Address - Zip Code:83442-1275
Practice Address - Country:US
Practice Address - Phone:208-757-8444
Practice Address - Fax:208-965-8351
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-19
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based